Correction of iron deficiency in hospitalized heart failure patients does not improve patient outcomes

Author(s):  
Ronak H. Mistry ◽  
Andrew Kohut ◽  
Patricia Ford
2019 ◽  
Vol 14 (11) ◽  
pp. 1-12 ◽  
Author(s):  
Jayne Masters ◽  
Carys Barton ◽  
Lynda Blue ◽  
Jenny Welstand

There are almost 1 million people diagnosed with heart failure in the UK, and this number continues to rise. It is a common cause of hospitalisation and costs associated with those hospitalisations account for a significant proportion of the NHS budget. Studies have demonstrated that community heart failure specialist nurses improve patient outcomes and reduce the costs associated with hospitalisation. Yet, despite increased prevalence, considerable advances in therapies, and new recommendations from the National Institute for Health and Care Excellence, the recommended number of heart failure specialist nurses per 100 000 has stayed the same. This article will describe the development of community heart failure nursing in the UK, and outline the challenges currently facing heart failure specialist nurses. It makes a number of recommendations that would ensure heart failure patients are able to be seen by a heart failure specialist nurse in a timely manner, help reduce inequalities of care, reduce costs associated with heart failure hospitalisations and help ensure sustainability of heart failure services over the longer term.


2016 ◽  
Vol 5 (1) ◽  
pp. u209822.w4076 ◽  
Author(s):  
Carl Hayward ◽  
Hitesh Patel ◽  
Chris Allen ◽  
Ali Vazir

Author(s):  
Joanna Sophia J Vinke ◽  
Marith I Francke ◽  
Michele F Eisenga ◽  
Dennis A Hesselink ◽  
Martin H de Borst

Abstract Iron deficiency (ID) is highly prevalent in kidney transplant recipients (KTRs) and has been independently associated with an excess mortality risk in this population. Several causes lead to ID in KTRs, including inflammation, medication and an increased iron need after transplantation. Although many studies in other populations indicate a pivotal role for iron as a regulator of the immune system, little is known about the impact of ID on the immune system in KTRs. Moreover, clinical trials in patients with chronic kidney disease or heart failure have shown that correction of ID, with or without anaemia, improves exercise capacity and quality of life, and may improve survival. ID could therefore be a modifiable risk factor to improve graft and patient outcomes in KTRs; prospective studies are warranted to substantiate this hypothesis.


2020 ◽  
Vol 27 (2_suppl) ◽  
pp. 27-34
Author(s):  
Stefania Paolillo ◽  
Angela B Scardovi ◽  
Jeness Campodonico

Cardiovascular and non-cardiovascular comorbidities are frequently observed in heart failure patients, complicating the therapeutic management and leading to poor prognosis. The prompt recognition of associated comorbid conditions is of great importance to optimize the clinical management, the follow-up, and the treatment of patients affected by chronic heart failure. Anaemia and iron deficiency are commonly reported in all heart failure forms, have a multifactorial aetiology and are responsible for reduced exercise tolerance, impaired quality of life, and poor long-term prognosis. Diabetes mellitus is highly prevalent in heart failure and a poor glycaemic control is associated with worst outcome. Two specific heart failure forms are usually observed in diabetic patients: an ischaemic cardiomyopathy or a typical diabetic cardiomyopathy. The implementation of use of sodium-glucose cotransporter-2 inhibitors will much improve in the near future the long-term prognosis of patients affected by heart failure and diabetes. Among cardiovascular comorbidities, atrial fibrillation is the most common arrhythmic disease of heart failure patients and it is still not clear whether its presence should be considered as a prognostic indicator or as a marker of advanced disease. The aim of the present review was to explore the clinical and prognostic impact of anaemia and iron deficiency, diabetes mellitus, and atrial fibrillation in patients affected by chronic heart failure.


2019 ◽  
Vol 35 (S1) ◽  
pp. 72-72
Author(s):  
Susan Myles ◽  
Ruth Louise Poole ◽  
Karen Facey

IntroductionEvidence supporting the use of pacemakers is well established. However, evidence about the optimal use of pacemaker telemonitoring for disease management in heart failure is not. Health Technology Wales (HTW) held a national adoption event to encourage implementation and best practice in use of pacemaker telemonitoring in the National Health Service (NHS) Wales to improve patient outcomes in heart failure.MethodsMulti-stakeholder national adoption workshop using a mixture of expert presentations, case studies and interdisciplinary group and panel discussions to agree key actions to understand the value and promote optimal use of pacemakers for remote disease monitoring in patients with heart failure in Wales.ResultsThe workshop was attended by forty-five senior professionals with an interest in improving care of patients with heart failure. Actions to progress included: providing a centralized Welsh system to support technical issues that arise with telemonitoring; considering interoperability with other NHS Wales systems; encouraging value-based procurement with collection of a core outcome set; agreeing implementation issues with both professionals and patients; audit to understand experience, resource use and outcomes; and sharing manufacturer evidence on the accuracy of telemanagement algorithms. It was suggested that these actions be progressed via an All-Wales multi-stakeholder approach, led by the Welsh Cardiac Network.ConclusionsDeveloping a more agile, lifecycle approach to technology appraisal is currently advocated; recalibrating the focus from technology assessment to technology management across the complete technology lifecycle. HTW will endeavour through regular adoption events to facilitate such a paradigm shift that aims to understand value and optimise use of evidence-based technologies.


2019 ◽  
Vol 6 (2) ◽  
pp. 241-253 ◽  
Author(s):  
Alejandro Martin‐Malo ◽  
Gerrit Borchard ◽  
Beat Flühmann ◽  
Claudio Mori ◽  
Donald Silverberg ◽  
...  

2019 ◽  
Vol 96 (1134) ◽  
pp. 206-211
Author(s):  
Steny Simon ◽  
Adam Ioannou ◽  
Stuart Deoraj ◽  
Sofia Metaxa ◽  
Amit K J Mandal ◽  
...  

Purpose of the studyIron deficiency anaemia (IDA) is associated with increased morbidity and mortality in heart failure patients. The aim of our audit was to evaluate the current practice in diagnosis and assessment of IDA in patients admitted with heart failure.Study designWe conducted a retrospective audit of patients admitted to our hospital between January 2017 and June 2017 with a diagnosis of heart failure, and obtained data regarding each patient’s demographics and anaemic status. We also conducted a qualitative survey to assess healthcare professionals’ ability to diagnose IDA, and their knowledge of iron replacement in heart failure patients.ResultsOur audit identified 218 heart failure patients, nearly two-thirds (n=138, 63.3%) of which were anaemic. Of the 138 anaemic patients, only 40 had a full haematinic screen compared with 98 who had incomplete investigations (29% vs 71%, p=0.007). Iron studies were the most commonly performed haematinic investigation (n=87, 63%), and over half of these patients were iron deficient (n=49, 56.3%). Only 12 (24.5%) iron deficient patients were prescribed oral iron therapy, while 37 (75.5%) were left without iron replacement (X2=12.8, p=0.0003). Our survey demonstrated a lack of awareness among healthcare professionals with only 19.7% of participants being able to correctly define anaemia and 9.1% being aware of guidelines regarding treatment of IDA.ConclusionMany patients admitted to hospital with heart failure also have a concomitant diagnosis of anaemia. The aetiology of the underlying anaemia is often poorly investigated, and where IDA is identified it is poorly treated.


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